There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
The Clinical Quality Consultant will drive consistency, efficient processes and share best practices - in a collaborative effort with the providers - designed to facilitate a minimum 4 STAR rating. The CQC will participate in quality improvement initiatives, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship.
- Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
- Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
- Be the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations.
- Assist in developing of training and analytical materials for Stars and HEDIS
- Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership.
- Analyze and evaluate provider group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
- Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes
- Focus communications and efforts accordingly
- Develop solution-based, user friendly initiatives to support practice success
This position requires up to 50% Travel throughout El Paso County and potentially New Mexico. Position will be onsite at 3801C Constitution Dr. #100 El Paso, TX 79922 when not traveling.
- Registered Nurse (within the states in which service is being delivered) with undergraduate degree or (4 years equivalent experience above and beyond the required years of experience may be considered in lieu of undergraduate degree)
- 4+ years of associated business experience within the health care industry including experience with HEDIS/Stars
- Experience influencing others resulting in changes in behavior (preferably with providers in various care delivery models)
- Strong knowledge of the Medicare market, products and competitors
- Knowledge base of clinical standards of care, preventative health, and Star measures
- Experience in managed care working with network and provider relations
- Financial analytical background within Medicare Advantage or government programs (Risk Adjustment/STARS Calculation models)
- Experience in provider-facing HEDIS strategy and education
- Experience presenting education of HEDIS/Stars material to providers and provider office staff
- Microsoft Office specialist with exceptional attention to detail; must be proficient with Excel
- Ability to travel locally up to 50 -75%, with occasional overnight travel
- Reliable transportation that will enable you to travel to client and/or patient sites within a designated area
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease
Preferred Education, Experience & Skills
- Undergraduate degree preferred, post graduate degree
- Billing and CPT coding experience
- Clinical data abstraction experience
- Medical/clinical background
- Strong communication and presentation skills
- Strong relationship building skills with clinical and non-clinical personnel
- Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
- Ability to solve process problems crossing multiple functional areas and business units
- Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
- Excellent customer service skills
- Good business acumen, especially as it relates to Medicare
Physical & Mental Requirements:
- Ability to lift up to 10 pounds
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to properly drive and operate a vehicle
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: quality, RN, Registered Nurse, Clinical quality, STARS, HEDIS, Travel, Provider education, El Paso, TX, Texas